Who has BCBS State Plan POS?

I have MY documentation of diets. I have been diagnosed with Hypertension,fibromyalgia,possible sleep apnea and degenerative disc disease. Do I still have to have 6 detailed months of pcp supervised diet? I am not sure how detailed she kept other than to write ....we discussed diet and exercise yada...yada....yada.... I am now going thru the gathering process and would appreciate any advice you may have.

GOT THE SAME PLAN.. THE 6 MONTHS THING I'VE HEARD IS A MUST. MY PCP SAID HE WOULD TAKE CARE OF IT. HE'S ALWAYS BEEN AWARE OF ANY WEIGHT PLAN I HAVE BEEN ON. I HAVEN'T GOTTEN TO THAT POINT WHERE MY PCP HAS WRITTEN TO MY INSURANCE YET SO I MIGHT RUN INTO A ROADBLOCK.. I GOT COPIES OF MY LAST THREE YEARS OF MY MEDICAL RECORDS. I ALSO GAVE A LIST OF WHEN I WENT TO A WEIGHT PROGRAM . HOW LONG I WAS ON IT AND WHAT I LOST.. I GAVE THIS TO MY PCP TO HELP HIM. GOOD LUCK...

Amanda, I have dealt with BCBS on several patients and specifically the state plan on a few. What they are looking for in the documentation is that you discussed diet and exercise, were you compliant, did you gain/lose/stay the same? If you were going to Weigh****cher's, Jenny Craig, LA weight loss, curves-any of those types of places, get documentation of that as well. Curves has a great print out that shows start weight, measurements, BMI and the monthly changes. Make copies of your WW book if you have it. List out for your PCP every diet you have been on for the last two years (2003-present), take it to him/her and ask him/her to "document an addendum" in your chart that says (this is a sample), "Amanda has been under my care since XXX, while under my care she has attempted the following weight loss methods: August 2003-Jan. 2004 WW and exercise, she lost 35# and regained 40#. March 2004-Oct. 2004 Atkins diet, lost 40# and regained all. We were unable to start her on Meridia due to a history of hypertension. While under my care she has failed at traditional weight loss and it is for these reasons that I feel her best opportunity for sustained weight loss is through surgical intervention." This should be submitted with the existing documentation to BCBS. He/she also needs to be willing to call BCBS and do a MD to MD appeal once they deny it. How do I know they'll deny it? Because they're BCBS and they always deny it initially. ALWAYS. It appears that they think there is a certain number of us who will just say, "oh well, it wasn't meant to be" and just give up. When they say no, keep going and going and going and eventually it will get approved, just be ready for a 2-3 month ordeal. Hang in there! Pam